Skin grafting involves surgically removing skin from one area of the body and transplanting it to another. A skin graft may be needed for many medical reasons, including loss of skin due to injury, burns, or illnesses such as skin cancer.
A full-thickness skin graft is a fully detached piece of skin taken from one body area and placed over a wound elsewhere. It consists of the full thickness of the epidermis and dermis layers of skin. The deep cut of the dermis includes blood vessels and other epidermal components that supply epithelial cells, aiding in the area adhering and healing properly. The most favorable areas for selecting full-thickness skin grafts are the forearm, abdomen, groin, and just above the collar bone.
What Are Other Categories of Skin Grafts?
In addition to the full thickness skin graft, there are other classifications of skin grafts. They include:
- Partial or split-thickness. This graft is a tissue-paper thin layer of skin that is shaved from an area that is expected to heal well, like the buttocks or calf. It consists of only the epidermis and partial dermis. The area of the graft may look light for a few months and then leave a faint scar.
- Autograft. When bone or tissue is transplanted from one area of the body to another.
- Allograft. When bone or tissue is transplanted from one person's body to another's.
- Xenograft. In this case, bone or tissue from one species is transplanted to another, such as a graft from a rabbit to a human, for example.
What Happens During a Skin Graft Procedure?
Before surgery, your doctor will choose the donor site, or the area of the body that will supply the tissue. This area must closely match where the graft will be transplanted. Sometimes, doctors will make a model of the wound from foil and compare it to the donor site. This model will then be outlined on the donor site with a surgical marker. For graft survival, the area that will receive the graft should not be contaminated and should have good vascularization, or blood flow. The area will be sterilized before the surgery.
For your skin graft surgery, you will either be given general or local anesthesia. This is at the discretion of your doctor.
During the procedure, the pre-chosen donor site for the full-thickness graft is surgically removed from the body. Once this is done, the tissue is trimmed of any underlying hair or fat tissue that may be present.
After the donor site is stitched closed, the graft is placed dermis side down onto the wound site. Care must be taken to prevent wrinkling or extreme stretching of the graft. Corner stitches are placed to hold the graft in correct alignment. The graft is then secured to the underlying wound base with simple interrupted suture stitching. The periphery of the graft is then stitched. For optimal skin graft recovery, the graft must maintain direct contact with the wound bed.
Antibiotic creams may then be applied, and a secure Telfa pressure dressing is placed over the surgical site. The consistent pressure over the wound immobilizes the site, aiding in skin graft recovery by preventing shearing or hematoma formation.
How Does the Skin Graft Heal?
Barring any complications, full-thickness grafts typically heal within three to four weeks. While your skin graft is healing, you should generally avoid strenuous activity for two or more weeks after surgery.
Unless there's odor, drainage, or pain, your bandages should be left in place for five to seven days after the procedure. This is the amount of time it takes for the graft to connect with the surrounding blood supply.
When it's time to remove the bandages, moisten them with sterile water to make sure the graft isn’t lifted from the base. Initially, the color of the graft may seem reddish, but as it goes through the healing stages, the color will normalize. This may take a year or so. The final color may be slightly different from the surrounding skin.